Herndon Alexandra, Chandran Kira, Davis Daniel P
University of California at Irvine, Irvine, California.
Georgetown School of Medicine, Washington, District of Columbia.
J Emerg Med. 2024 Dec;67(6):e523-e532. doi: 10.1016/j.jemermed.2024.06.011. Epub 2024 Jun 20.
Preoxygenation is critical to safe performance of rapid sequence intubation (RSI). The use of positive-pressure ventilation (PPV) has been advocated during preoxygenation but may increase the risk of aspiration.
To explore the risk-benefit analysis of using PPV during air medical RSI.
We performed a retrospective analysis of the Air Methods Airway Registry using patient data from over 175 bases across the U.S. over a 5-year period. Patients were separated into normoxemic (SpO2 ≥93%) and hypoxemic (SpO2 <93%) and compared in regard to demographics, clinical data, and use of PPV. Primary outcomes were first-attempt intubation success (FAS) and FAS without desaturation (FASWD). Chi-square, t-test, and logistical regression were used to analyze the data.
There were 9778 patients who underwent intubations during the study period. FAS was 92% (8966 patients). FASWD was 90% (8775 patients). Mean SpO2 was 94.9%. There were 42% (4118 patients) of patients who received PPV prior to intubation and 1% (94) aspirated during RSI. Multivariate logistical regression showed an association between use of PPV and reduced intubation success for normoxemic patients but improved intubation success for hypoxemic patients. The use of PPV was associated with higher risk of aspiration events (p = 0.007).
The use of PPV during preoxygenation prior to RSI appears beneficial for hypoxemic but not normoxemic patients due to lower intubation success and increased aspiration risk with PPV. This data supports selective use of PPV prior to the initial intubation attempt in patients undergoing RSI.
预给氧对于快速顺序诱导插管(RSI)的安全实施至关重要。在预给氧期间提倡使用正压通气(PPV),但这可能会增加误吸风险。
探讨在航空医疗RSI中使用PPV的风险效益分析。
我们对航空医疗气道注册数据库进行了回顾性分析,使用了美国175多个基地在5年期间的患者数据。将患者分为血氧正常(SpO2≥93%)和低氧血症(SpO2<93%)两组,并就人口统计学、临床数据和PPV的使用情况进行比较。主要结局指标为首次插管成功率(FAS)和未发生血氧饱和度下降的首次插管成功率(FASWD)。采用卡方检验、t检验和逻辑回归分析数据。
研究期间有9778例患者接受了插管。FAS为92%(8966例患者)。FASWD为90%(8775例患者)。平均SpO2为94.9%。42%(4118例患者)的患者在插管前接受了PPV,1%(94例)在RSI期间发生误吸。多因素逻辑回归显示,对于血氧正常的患者,使用PPV与插管成功率降低相关,但对于低氧血症患者,插管成功率提高。PPV的使用与误吸事件的较高风险相关(p = 0.007)。
在RSI前预给氧期间使用PPV,对于低氧血症患者似乎有益,但对于血氧正常的患者则不然,因为PPV会降低插管成功率并增加误吸风险。该数据支持在接受RSI的患者首次插管尝试前选择性使用PPV。